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Medicaid expansion set for a vote Wednesday

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Modified: April 20, 2013 at 10:28 am •
Published: April 20, 2013

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BATON ROUGE, La. (AP) — Nearly a year after Gov. Bobby Jindal declared that Louisiana wouldn't tap into billions of federal dollars to expand Louisiana's Medicaid program, lawmakers will take their first vote on whether to challenge his stance.

Political squabbling over the federal health care law championed by President Barack Obama will be the nearly sole focus of Wednesday's House Health and Welfare Committee hearing.

Five measures on the agenda, all sponsored by Democrats, seek to enact the Medicaid expansion under the law. Similar proposals await debate in the Senate.

Both sides are expected to arrive armed with facts, figures and strong political rhetoric about the federal Affordable Care Act. Republican and Democratic party officials have fired off attacks in anticipation of the Medicaid expansion debate.

Jindal, considered a possible 2016 presidential candidate for the GOP, has made rejection of the Medicaid expansion a central plank of his political philosophy. Democrats accuse the governor of putting his political ambitions ahead of citizens' health care.

But the issue has grown murkier than partisan politics. Several Republican lawmakers — particularly in the Senate — have suggested the state should at least consider different expansion models to offer coverage to hundreds of thousands of uninsured.

Jindal said the expansion would eat into state dollars that would otherwise pay for education and infrastructure, expand an inefficient health care program and shift people from private insurance to taxpayer-funded Medicaid. He said the expansion would mean 41 percent of Louisiana's residents would be on Medicaid.

"We can't continue to grow this program. It would be unsustainable. We cannot continue to put more and more people into these expensive entitlements, into these expensive government-run programs," the governor said Thursday.

Estimates are that anywhere from 675,000 to more than 800,000 people are uninsured in Louisiana.

The Louisiana Hospital Association, which represents private and community hospitals, has announced its support of the Medicaid expansion. It also has been championed by Democratic U.S. Sen. Mary Landrieu, and health care advocacy groups are pushing it as a moral imperative for a poor and unhealthy state.

"Medicaid expansion offers a path to regular access to health care for working adults," former Louisiana health secretaries David Hood and Fred Cerise said in a newspaper ad promoting the expansion.

Rep. Walt Leger, D-New Orleans, the No. 2 ranking member of the Louisiana House, said the expansion would provide health care coverage to 400,000 uninsured people, save the state money, improve the financial stability of Louisiana's hospitals and pump new money into the economy to create new jobs.

The potential expansion would cover adults making up to 138 percent of the poverty level — $15,420 a year for an individual or $31,812 for a family of four. The federal government will cover the full costs of the Medicaid expansion from 2014 to 2016 and pick up most of the price tag after that, requiring states to pay up to 10 percent.

Louisiana would get an estimated $15 billion to $16 billion in federal Medicaid funding over a decade to cover the additional low-income residents.

Both opponents and critics cite financial estimates from a recent report by the state Department of Health and Hospitals to bolster their positions on the state's costs.

The DHH report says Louisiana could save up to $368 million over 10 years while covering more than 577,000 additional people through Medicaid, figures referenced by supporters of expansion. The savings can be attributed to lessening existing state costs for providing health care to the uninsured.

Jindal cites the numbers on the high end of the DHH report, which estimates that if 653,000 new people are covered and the Medicaid expansion forces up the rates paid to doctors and other health providers, the state could face a price tag reaching $1.7 billion over a decade.

Lawmakers, particularly Republicans in the Senate, have urged the Jindal administration to consider a private insurance Medicaid expansion model, like Arkansas.

Louisiana's neighboring state has asked federal officials to let it use the Medicaid money to buy private insurance policies, and the Obama administration is working with the state on that idea.

But Jindal's interim DHH Secretary Kathy Kliebert dismissed that concept in a recent legislative hearing, saying the federal guidelines outlined for the Arkansas proposal still leave too much uncertainty about future financing and regulations.

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Online:

House Concurrent Resolutions 4 and 8 and House Bills 110, 233 and 449 can be found at www.legis.la.gov